MEDICARE: KARRIE MCDONOUGH DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305207640	VA
2	225100000X	Physical Therapist	PT871261	DC
3	225100000X	Physical Therapist	CP035214T	NV

General Provider Information

NPI Number	:	1194000596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRIE MCDONOUGH DPT

Provider Business Mailing Address
First Line	:	3425 CLIFF SHADOWS PKWY STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5113
Country	:	US
Telephone Number	:	702-448-6042
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 CLIFF SHADOWS PKWY STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5113
Country	:	US
Telephone Number	:	702-448-6042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	05/20/2026

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